Order ESS/1187/2015, of June 15, which develops Royal Decree 625/2014, of July 18, which regulates certain aspects of the management and control of processes for temporary incapacity in the first three hundred and sixty-five days of its duration.
Royal Decree 625/2014, of July 18, established a new regulation of temporary incapacity processes during the first three hundred and sixty-five days, in any Social Security scheme and with effects from September 1, 2014.
To develop said Royal Decree , Order ESS/1187/2015, of June 15 , has just been issued , which more exhaustively regulates the processes of processing medical leave and confirmation, medical discharges and the control of situations of temporary incapacity.
This Order will come into effect on December 1, 2015.
Its main highlights are:
Content
Essentially, Order ESS/1187/2015 introduces new models of medical certificates for sick leave/return to work and confirmation of temporary incapacity (included as annexes to the regulation), which will be used from the temporary incapacity processes that are in progress on the indicated date of entry into force and have not exceeded 365 days, although the periodicity and mandatory data are those required by the previous regulations.
We highlight the following aspects not included in Royal Decree 625/2014, which it develops
A) Regarding sick leave and its confirmation
1) The tables of optimal duration of pathological processes and tables on the degree of incidence of said processes in the work activities on which the physician bases the assignment of the estimated duration of the IT process, will be supplied and reviewed periodically by the National Institute of Social Security.
2) Medical professionals, both from the public health service and from the mutual insurance company in the event that the medical leave is due to a work accident or occupational disease, will issue the medical certificate of temporary incapacity using the new model shown in Annex I.
3) Confirmation reports will be issued using the new model shown in Annex II.
4) In those processes of very short estimated duration (less than 5 calendar days), the doctor will issue the sick leave and discharge certificates in the same medical act using a single certificate according to the model shown as Annex I, stating the data relating to the sick leave and the identifications of the discharge and the date of the discharge, which may coincide with the day of the sick leave or be within the following three calendar days.
However, the worker may request a medical examination on the day set as the discharge date and, if the doctor considers that the worker has not recovered his work capacity, he may modify the estimated duration of the process, issuing a confirmation of sick leave that will cancel the discharge initially planned, indicating the diagnosis, the new estimated duration, the type of process and the date of the next medical review.
5) Regardless of the estimated duration of the process, the doctor will issue the medical discharge for cure or improvement that allows the usual work to be performed, when he considers that the worker has recovered his work capacity, for proposal of permanent disability or for start of a maternity situation.
6) If the worker does not attend the medical review scheduled in the sick leave and confirmation reports, a medical discharge due to non-appearance may be issued.
7) If there is a modification or update of the diagnosis or a change in the estimated duration, a confirmation report will be issued stating the updated diagnosis, the new estimated duration and the date of the next review.
8) When a worker on temporary disability begins receiving healthcare from a different public health service, this circumstance must be reflected in the immediately preceding confirmation report, as well as the date on which the next medical review will be carried out by the new public health service.
9) When issuing the final confirmation report before the 365-day period expires, the physician must inform the worker during the medical examination that, once this period has ended, the INSS (National Social Security Institute) will be responsible for monitoring the process from then on. This is without prejudice to the public health service or the mutual insurance company continuing to provide healthcare.
For this purpose, in the confirmation report the doctor will complete the section corresponding to the transfer to control by the INSS, indicating the day of completion of the 365 calendar days in a situation of temporary incapacity.
In turn, the public health service will communicate this date electronically to the INSS immediately upon its fulfillment and, in any case, no later than the next working day.
10) In processes where the subsidy is the responsibility of a mutual insurance company, the INSS will immediately inform the company that the process has reached 330 calendar days in duration, indicating that from the exhaustion of the 365 days it will exercise the powers relating to temporary incapacity (extension, discharge).
In cases of work-related accidents and illnesses, once the aforementioned notification has been received and before the temporary incapacity reaches 345 calendar days, the mutual insurance company may submit a reasoned proposal for action to the National Social Security Institute (INSS), which will not be binding. The INSS will issue an express decision.
B) Regarding medical discharge
1) Discharge certificates will be issued using the new model shown in Annex I (i.e., the same as for the discharge certificate).
2) The communication of the discharge report by the INSS or the ISM to the public health service or the mutual insurance company will be carried out electronically, immediately and, in any case, on the first working day following its issuance.
Likewise, the registration requests that the mutual societies make to the INSS or the IMS will be carried out electronically:
– If the managing entity considers that it is not appropriate, it will communicate this to the mutual insurance company electronically, immediately and, in any case, on the first working day following the adoption of the decision.
– If the managing entity considers it appropriate, it will issue the report and communicate it in the usual way.
3) If the medical discharge certificate has been issued by the INSS or the IMS, these will be the only ones competent to issue a new sick leave certificate for the same or similar pathology, during the one hundred and eighty calendar days following the date on which the discharge was issued, using the model in Annex I.
Such absences will be reported to the public health service or to the mutual insurance company when they are responsible for providing the financial benefit.
C) Issues common to both registration and deregistration
1) If the doctor does not have electronic means, he will carry out the actions through medical reports in paper format, and the public health service or the mutual insurance company will transmit electronically to the INSS the data corresponding to said reports within two working days following their issuance.
2) In cases of very short estimated duration (less than 5 days), the employee will submit to the company the copy of the sick leave/return to work certificate intended for the company within 24 hours of the return to work date. If the physician issues the first confirmation certificate because they consider that the employee has not recovered their ability to work, the employee will submit it to the company within the following 24 hours, along with the initial sick leave certificate.
3) The company will record the following on the copy of the sick leave certificate submitted by the employee:
– Contribution data relating to the worker.
– National occupation code key.
– Province code of the health center issuing the report.
– Generic identifying data that is established through the Electronic Data Submission system (RED).
4) The company shall transmit to the INSS (National Social Security Institute) the sick leave, confirmation, or return-to-work certificate submitted by the employee, after completing the relevant sections, through the RED system, immediately and, in any case, within a maximum period of three business days from its receipt. This applies even if the company has assumed the payment of the temporary disability benefit under a voluntary collaboration agreement.
This obligation will also apply to business groups and registered professionals.
5) Only the INSS and the ISM may consult, process, and use the data included in the reports. The TGSS may consult them exclusively in relation to specific contribution conditions regarding workers on sick leave.
In any case, the transmission, transfer, processing and exploitation of the data collected in the copies of the medical reports are subject to the Organic Law on the Protection of Personal Data
6) The models of the copies of the medical reports in paper format must be kept by the companies for a period of four years, starting from the date of their electronic submission.
D) Regarding the control of temporary disability situations
1) When the management of temporary incapacity corresponds to the public health service, the Health Services Inspection of the Social Security or equivalent body, or the primary care physician under its supervision, will issue a quarterly medical report on the control of the incapacity in which all the details that justify the need to maintain the temporary incapacity are stated.
2) The public health services shall make the aforementioned medical control reports available to the medical inspectors assigned to the INSS or the ISM, or to the physicians of the mutual insurance companies, within five working days of their issuance. The same applies to supplementary medical reports and their updates, and to the medical tests carried out throughout the process.
If you require our assistance to obtain more information or have any questions, please contact us via email at ambit@ambitassessor.com or at our offices.
Meritxell Arnal
Area Director
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